Reducing tardiness from scheduled start times by making adjustments to the operating room schedule.

BACKGROUND: Tardiness from scheduled start times is a common source of frustration for both operating room (OR) personnel and patients. Factors that influence tardiness were quantified in a companion paper and have been used to develop interventions that have the potential for reducing tardiness.

METHODS: Data from two surgical suites were used to compare the effectiveness of several interventions to reduce tardiness, including i) moving cases to different ORs on the afternoon of surgery, ii) recalculating the OR schedule when it is published to correct for average lateness in first cases of the day, iii) recalculating the OR schedule when it is published to correct for average service-specific case duration bias, and iv) scheduling a gap (time buffer) before the cases of a "to follow" surgeon if the day is expected to end early. These last three interventions involve creation of a modified schedule with revised start times that are more accurate for both patient and "to follow" surgeon. The surgeon performing the first case of the day would not be affected.

RESULTS: Moving cases to different ORs when a room was running late produced a 50%-70% reduction in the tardiness for those cases that were moved. However, overall tardiness in each suite was reduced by only 6%-9%, because few cases were moved. Scheduling a gap between surgeons if the day was expected to end early reduced tardiness by more than 50% for those cases that were preceded by gaps. However, overall tardiness in each suite was reduced by only 4%-8%, because few gaps could be scheduled. In contrast, correcting for the combination of lateness in first cases of the day and service-specific case duration bias reduced overall tardiness in each suite by 30%-35%.

CONCLUSIONS: Interventions which involve small numbers of cases have little potential to reduce overall tardiness. Generating a modified or auxiliary OR schedule that compensates for known causes of tardiness can significantly reduce patient and "to follow" surgeon waiting times. Modifying the OR schedule to create revised start times for patients and "to follow" surgeons involves interventions that are simple to perform. The official schedule is not changed and case sequencing is not altered. Results do not depend on changing surgeon, anesthesia provider, or nursing behavior.